Irvin S M, Harrison S A
Ambulatory Surgery Unit/Supervisor, Outpatient Surgical Clinics, Tennessee, USA.
SCI Nurs. 1996 Dec;13(4):88-95.
High acuity nursing involves caring for clients who have potentially life-threatening conditions. This care is described as required, due to a disruption in one or more principal organ systems. How high acuity care is differentiated from acute or long term care may be dependent on the client's initial overall condition and/or predicted outcome. The client discussed has sustained a spinal cord injury at the C5 level. This presentation will demonstrate how clients may continually pass through high acuity care circumstances, acute care, to ultimately a long term care situation. Description of this client in a case study format may result in a learning experience for practitioners concerned with the physiological and the psychosocial aspects of their clients who require high acuity, acute and/or long term care. Car or motorcycle accidents account for at least half of all spinal cord injuries. Most are injuries involving cervical segments number 5 and 6. Cord damage can ascend or descend as much as three levels above or below the injury, due to edema or cord compression post trauma (Woll, 1986). Accidents with severe damage to the spinal cord at the C5 level can result in quadriplegia. Injuries of this magnitude can be either complete or incomplete. Complete injuries cause a "... loss of all conscious motor and/or sensory function below the level of injury" while incomplete injury spares some function, motor and/or sensory (Zejdlik, 1992, p.66). The purpose of this article is to present a client case study as a model for practitioners who practice in high acuity, acute, and long term situations. Two nursing theories (self-care deficit and adaptation) will be used as a framework for the case study. An assessment of the client's physical findings, including history, physical examination, and psychosocial status will be described. Nursing diagnoses and nursing interventions for two specific clinical problems will be presented. Recommendations for future research, nursing care and/or referrals will be outlined.
高 acuity 护理涉及照顾患有潜在危及生命状况的患者。由于一个或多个主要器官系统的功能紊乱，这种护理被认为是必要的。高 acuity 护理与急性护理或长期护理的区别可能取决于患者最初的整体状况和/或预测结果。所讨论的患者在 C5 水平发生了脊髓损伤。本报告将展示患者如何不断地从高 acuity 护理情况过渡到急性护理，最终进入长期护理状况。以案例研究的形式描述该患者可能会为关注高 acuity、急性和/或长期护理患者生理和心理社会方面的从业者带来学习体验。汽车或摩托车事故至少占所有脊髓损伤的一半。大多数损伤涉及第 5 和第 6 颈椎节段。由于创伤后水肿或脊髓受压，脊髓损伤可在损伤部位上方或下方多达三个节段处向上或向下扩展（Woll，1986）。C5 水平脊髓严重损伤的事故可导致四肢瘫痪。这种程度的损伤可以是完全性的，也可以是不完全性的。完全性损伤导致 “…损伤水平以下所有有意识的运动和/或感觉功能丧失”，而不完全性损伤则保留一些运动和/或感觉功能（Zejdlik，1992，第 66 页）。本文的目的是呈现一个患者案例研究，作为在高 acuity、急性和长期护理环境中执业的从业者的模型。两种护理理论（自我护理缺陷理论和适应理论）将被用作案例研究的框架。将描述对患者身体检查结果的评估，包括病史、体格检查和心理社会状况。将提出针对两个特定临床问题的护理诊断和护理干预措施。将概述对未来研究、护理和/或转诊的建议。
